What Is Bell's Palsy?

Bell's palsy is Bell's palsy, also known as acute idiopathic peripheral facial paralysis. Because it is an acute unilateral paresis (palsy) or paralysis of unknown etiology, it is also called idiopathic facial nerve palsy, which is the most common cause of clinical facial paralysis. Facial nerve palsy can cause severe psychological and mental disorders to patients and seriously affect social and quality of life. If it is permanent complete facial paralysis, care is not taken to protect the cornea, which can easily cause corneal ulcers and blindness.

Basic Information

nickname

Acute idiopathic peripheral facial paralysis

English name

Bell palsy

Visiting department

neurosurgery

Common causes

Cold, fatigue, decreased immunity and immune deficiency

Common symptoms

Facial palsy with diminished taste, dry eyes, stuffy nose, and difficulty chewing

Causes of Bell's Palsy

Bell's palsy is now different from the original concept of CharlesBell (1829). The pathogenesis is inconclusive. There are currently herpes simplex virus (HSV-1) infection doctrines, immune damage doctrines, and facial nerve ischemia doctrines. The main causes are cold, fatigue, decreased resistance and immune deficiency.

Bell's palsy clinical manifestations

1. good group

According to the latest literature, the incidence of Bell's palsy is 11.5 / 100,000 to 53.3 / 100,000 / year.

(1) Incidence rate of 20 to 40 years old increased significantly. The ratio of men to women is the same.

(2) Risk factors: diabetes, pregnancy or menstrual period.

2. Symptoms of the disease

(1) Prodromal symptoms: often sudden onset after the head and face are stimulated by cold wind or other stimuli, or a history of viral infection often 7 to 10 days before onset May or may not be accompanied by pain in the ears or behind the ears, ranging in severity.

(2) Facial palsy: It may be partial or complete facial paralysis. The peak period is 10 to 14 days.

(3) Accompanied by decreased taste, dry eyes, stuffy nose, and difficulty chewing.

3. Disease hazards

Facial nerve palsy can cause severe psychological and mental disorders to patients and seriously affect social and quality of life. If it is permanent complete facial paralysis, care is not taken to protect the cornea, which can easily cause corneal ulcers and blindness.

Bell's palsy check

1. Otolaryngology head and neck examination

A comprehensive examination of the head, neck and neck of the otolaryngology. Peripheral facial paralysis of varying degrees on the ipsilateral ear needs to determine the cause, the extent of facial nerve injury, the location of the facial nerve injury, and the outcome and prognosis of facial nerve recovery (table).

(1) Determine the degree of facial nerve injury House-Brackmann (1985) grade of facial nerve injury

table	Degree and grade of facial nerve injury
degree of damage	Grading	definition
normal	Class I	All areas function normally
Mild dysfunction	Class II	You can see a slight weakness when you check it carefully. You can close the eyes gently to fully close it. A slight asymmetry appears when you smile.
Moderate dysfunction	Class III	Obvious joint movement, but not disfiguring
Moderate to severe dysfunction	Class IV	Disfigured, can not raise eyebrows, close eyes tightly but cannot close eyes, asymmetry of mouth angle, serious complications appear
Severe dysfunction	Class V	I can feel the movement of closing eyes just now, the corner of mouth can move slightly, no complications
Complete paralysis	Class VI	No exercise, loss of muscle tone, no complications

Electrophysiological examination can use nerve excitability test, facial nerve electrogram and electromyography to dynamically observe the recovery of facial nerve function. The electroencephalogram of the facial nerve should dynamically observe the number of degeneration of the facial nerve fibers 4 to 5 days to 21 days after the facial paralysis. If the degeneration of the nerve fibers reaches 90%, it is a surgical indication of facial nerve decompression. After 21 days of facial paralysis, the electromyogram of the face was dynamically observed. If the defibrillated fibrillation potential gradually changes to single-phase motor unit potential and multi-phase motor unit potential, conservative treatment can be considered.

(2) The location of the facial nerve injury can be determined through the tear test, stapedius reflex, and taste test. The flow of the submandibular gland is less accurate than that of traumatic facial paralysis.

(3) To determine the prognosis of facial nerve injury , we should make a comprehensive judgment based on electroencephalogram (ENoG), electromyogram, sacral muscle reflex, submandibular gland flow test, patient age, and recovery time of facial paralysis.

2. Auxiliary inspection

(1) The T2 signal of the facial nerve, especially the knee ganglion, can be seen by enhanced magnetic resonance imaging examination . Occupying lesions in the inner auditory canal and parotid gland were excluded.

(2) Make corresponding examinations for suspected systemic lesions

Bell's palsy diagnosis

The diagnosis of Bell's palsy is based on the comprehensive judgment of medical history, general examination, specialist examination, audiological evaluation, electrophysiological examination and imaging examination results. The diagnosis should be based on the exclusion method and the exclusion of peripheral facial paralysis with a clear etiology.

Differential diagnosis of Bell's palsy

Other diseases that cause peripheral facial paralysis, such as ear shingles, otitis media, cholesteatoma of the middle and outer ears, and apical cholesteatoma, trauma (barotrauma, birth injury, and temporal bone fracture, etc.), benign and malignant tumors in the temporal bone ( Such as acoustic neuroma, facial nerve sheath tumor or fibroma, tympanic tumor, middle ear cancer, external ear canal malignant tumor, endolymphatic papilloma, leukemia or metastatic cancer, etc., parotid disease (especially malignant tumor in the parotid gland) and Lyme Disease, human immunodeficiency virus (HIV), Guillain-Barre Syndrome and other nervous systems, immune system, facial paralysis caused by metabolic factors, and congenital facial paralysis (Mobius syndrome) or syndrome facial paralysis (Kawasaki syndrome, Melkersson-Rosenthal syndrome Sign).

Bell's palsy complications

Caused by facial nerve regeneration insufficiency and nerve fiber dislocation regeneration. There are crocodile tears, joint movement (group exercise), and facial twitches.

Bell's palsy treatment

Drug treatment

(1) Glucocorticoids can play an anti-inflammatory role in the acute phase to reduce the immune response, suppress the inflammatory response of the facial nerve, reduce the pressure in the facial nerve bone tube with a fixed diameter, thereby reducing the facial nerve's exposure to edema and thickening Facial nerve bone canal compression, the degree of microcirculation disturbance, therefore, glucocorticoid therapy is the first and main drug treatment of the disease, but it should not be used for a long time. Pay attention to diabetes, tuberculosis, gastric ulcer and pregnant women. Use with caution in children to prevent growth and development. People with hypertension should pay attention to controlling blood pressure.

(2) Antiviral drugs can interfere with herpes virus DNA polymerase and inhibit DNA replication. Acyclovir (aciclovir) is commonly used, but ganciclovir, famciclovir, or valenevir may also be used.

(3) Intramuscular injection or oral administration of neurotrophic drugs or energy mixtures such as vitamin B ₁ and vitamin B ₁₂ . ATP intramuscularly or intravenously. Coenzyme A was dripped intravenously.

(4) Ginkgo biloba extract or other vasodilators are used to improve the microcirculation of the facial nerve. The drugs to improve the microcirculation are injected intravenously or orally.

(5) Pain Relief Pain Remedy can be used appropriately for severe ear pain.

(6) Eye ointments and eye drops At night, eye ointments, such as tetracycline or erythromycin eye ointment, can be applied to the affected eye, and the eyes are protected with eye masks. Artificial tears can be used when tears are reduced.

2. Surgical treatment

Facial nerve decompression: When the facial nerve electrogram shows that the number of facial nerve fibrosis has reached 90% to 94%, clinically found that there is no improvement in facial nerve function and progressive worsening, facial nerve decompression should be performed in time.

3. Other treatments

(1) Traditional Chinese medicine and acupuncture can play an adjunct role. In the acute phase (1 to 2 weeks), it is not appropriate to use strong stimulation such as acupuncture. After the acute phase, acupuncture can be used. Huoxuehuayu drugs have an auxiliary effect on improving facial nerve microcirculation. Antipyretic and detoxifying drugs can also be used to fight the virus.

(2) In the acute phase, heat therapy , physical therapy, facial massage, etc. can be supplemented with warm therapy, magnetic therapy or electromagnetic therapy, ultrashort wave or microwave, laser and direct current drug iontophoresis. During the recovery period, physical therapy such as muscle massage and training can be used. Facial spasm can be treated with magnesium ion introduction, spasm muscle movement point block therapy such as injection of phenol solution, botulinum toxin and so on.

Bell's palsy prognosis

Bell's palsy is a self-limiting disease with a partially self-healing rate. A randomized, double-blind, controlled study showed that most patients (especially those with mild or moderate injuries) completely recovered neurological function after glucocorticoid treatment. The degree of facial paralysis recovery is related to the number of degenerated facial nerve fibers. The recovery of facial paralysis is also related to outcome. Younger patients recover faster and have a better prognosis than older patients.

Bell palsy prevention

Strengthen the body's resistance. take more exercise. Avoid colds, excessive fatigue, and mental stress to prevent colds.

References:

1.NewtonJ.CokerU.Fisch.DisordersoftheFacialNerve.Otolaryngology, ENGLISHRevisedEdition 1996.Volume1.chapter40.Lippincott RavenPublisbers.

2. ThomasB, NinaB, ElinM, etal. The Effect of Prednisoloneon SequelaeinBell'sPalsy: ArchivesofOtolaryngology ~ Head & NeckSurgery, 2012: 138: 445 ~ 449.